Reduced aniseikonia in axial anisometropia with contact lens correction

Aniseikonia, although present in isometropia, is associated principally with anisometropia and is widely thought to be the result of differences in the retinal image size presented to each eye. This assumes that equating retinal image size results in congruous cortical images. To test this assumption 1 refractive and 17 axial anisometropic subjects were examined to determine the aniseikonia present when corrected with spectacles and contact lenses. Contrary to many previous predictions, based upon Knapp's Law, the presence of equal retinal images resulted in larger aniseikonias than observed when the eyes were presented with unequal retinal images. This suggests that non-optical components have a significant role in the production of the cortical image, and this therefore requires a shift in the way the management of anisometropia is considered clinically. Contact lens correction maintains the aniseikonia at a minimum level in axial as well as refractive anisometropia and offers the clinician an acceptable practical alternative when prescribing for these patients.